1184722464 NPI number — INFECTIOUS DISEASES-MINNEAPOLIS-LTD

Table of content: (NPI 1184722464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184722464 NPI number — INFECTIOUS DISEASES-MINNEAPOLIS-LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASES-MINNEAPOLIS-LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184722464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 BOTTINEAU BLVD
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-3183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-4320
Provider Business Mailing Address Fax Number:
763-520-7055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 BOTTINEAU BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55429-3183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-4320
Provider Business Practice Location Address Fax Number:
763-520-7055
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHROCK
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-520-4320

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  834 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com